-Placenta percreta is diagnosed usually in the third trimester as massive postpartum
hemorrhage when an attempt to remove the placenta reveals lack of a cleavage plane.
However, placenta percreta may present in the second trimester with signs and symptoms
of uterine rupture. The diagnosis of this event may be difficult because of mild abdominal
discomfort often associated with normal pregnancy. We describe two cases that occurred
in the second trimester with an unusual presentation. Both patients suffered considerable
surgical morbidity. Other cases reported in the literature are mentioned as well.
When a patient with risk factors for abnormal placentation presents with abdominal
pain and/or vaginal bleeding in the second trimester of pregnancy, the diagnosis of
placenta percreta should be considered. A laparotomy is indicated immediately when
hemoperitoneum is suspected because uterine rupture has most likely occurred. Placenta
percreta in the second trimester is a potentially life-threatening condition that
warrants expeditious diagnosis to limit maternal postoperative morbidity.
Placenta percreta - hemoperitoneum - midtrimester
